Method for predicting moderate and pronounced erythrocyte lysis following cardiopulmonary bypass surgery

FIELD: medicine.

SUBSTANCE: patient's pre-operative health is assessed with taking into account the presence/absence of pulmonary and renal diseases, erythrocyte Rh C-antigen, hyperinosemia of more than 4 g/l and erythrocyte count of 4.81×1012/l and less; a haemolytic perfusion risk (HPR) is calculated by formula HPR=(6.38×Xpulm+8.93×Xhyp+3.32×XEr)-(4.10×Xren+2.95×XC), wherein the numerical values 6.38; 8.93; 3.32; 4.10; 2.95 are coefficients; Xpulm is the presence (1)/absence (0) of pulmonary diseases; Xhyp is the presence (1)/absence (0) of pre-operative hyperinosemia; XEr is the presence (1)/absence (0) of the pre-operative erythrocyte count 4.81×1012/l and less; Xren is the presence (1)/absence (0) of renal diseases; XC is the presence (1)/absence (0) of erythrocyte Rh C-antigen; if HPR>6.1, pronounced erythrocyte lysis is predicted; HPR<6.1 shows moderate erythrocyte lysis.

EFFECT: method enables increasing accuracy, information value and accessibility of the erythrocyte lysis prediction.

2 ex, 1 dwg, 3 tbl

 

The invention relates to the field of medicine, cardiac surgery, perfusely, cardiology, resuscitation and can be used to predict moderate and pronounced hemolysis after coronary artery bypass surgery under extracorporeal circulation.

Currently the problem of the development of pronounced hemolysis after operations with CPB remains important, as intraoperative increase the level of free hemoglobin in the blood in varying degrees observed in all cardiac surgery patients operated with the use of the most advanced in vitro technologies. If there individual predisposition of the patient to severe hemolysis intensity cytolysis of red blood cells during perfusion, multiplies and may cause formation of severe hemolysis-mediated postoperative complications: transient dysfunction of the kidneys and lungs after surgery to failure of these organs, disseminated intravascular coagulation and multiorgan failure. The methods for predicting pronounced intraoperative hemolysis available for clinical practice and does not require additional laboratory tests, based either on the account already diagnosed before the operation accompanying hematologics�th pathology, or (for patients not suffering any) on account of features used perfezionamento equipment and conditions of operations.

Known method for predicting pronounced intraoperative hemolysis in cardiac surgery patients with sickle cell anemia and thalassemia, which includes the analysis of the characteristics of these diseases before surgery - their form, severity: the severity of anemia prior to surgery higher the level and gemoglobinemii after surgery is expected to be above [1]. The disadvantage is a rare occurrence data of anemia, especially among Caucasian populations, in this connection, the absence of these diseases as comorbidities in cardiac surgery patients does not guarantee the absence of hemolysis after IR.

Known method for predicting postperfusion gemoglobinemii in cardiac surgery patients with a deficiency of the enzyme glucose-6-phosphate dehydrogenase in erythrocytes: the more preoperative insufficiency of the enzyme, the level of hemoglobinemia after operations with CPB [2]. The disadvantage of this method is limited in its use only in patients with profound deficiency of this enzyme, which are clinical manifestations of anemia, and the disease is diagnosed before surgery. I ballsachs these patients minor enzyme deficiency are asymptomatic and only in the IR manifested a marked hemolysis, it is impossible to predict in the preoperative period without additional tests.

Known method for predicting pronounced intraoperative hemolysis in cardiac surgery patients with disease cold agglutinins, which under normal conditions does not show itself and manifests itself already in the time of surgical intervention associated with hypothermia: the discovery of this type of red cell antibodies prior to surgery testifies in favor of massive development gemoglobinemii after hypothermic perfusion [3]. The disadvantage is the need for additional research in all patients with the aim of finding individuals with an extremely rare type of red cell antibodies are associated with poor management of economic resources.

Known method for predicting the severity of intraoperative hemolysis in cardiac surgery patients based on the analysis of the forthcoming operation. Take into account the type of equipment used, the estimated duration of the IR and the temperature of the perfusion, the intensity of the coronary suction (dependent on operational access), transfusion of blood products. The lower the temperature of perfusion and longer its duration, the severity of hemolysis left during�, the use of drugs donated blood does not significantly affect the severity of hemolysis [4]. In addition, the use of membrane oxygenators, centrifugal and roller pumps with incomplete occlusion is most preferable than the bubble oxygenator and roller pump with total occlusion; less haemolytic effect of providing a silicone and glass than polyvinyl chloride and Teflon; use of highways with a biocompatible coating has several advantages over uncoated systems [5]. The main drawback of this approach is that it is difficult to predict the final level gemoglobinemii, so as to determine the contribution of each of the conditions IR is difficult, but the most important method completely ignores the clinical status of the patient before the operation.

Thus, available for clinical practice methods of forecasting pronounced hemolysis in patients after operations with CPB or based on the analysis of the functional state of the patient, but is only applicable for patients with hematological diseases or used in patients without hematological pathology, but then do not consider their clinical status. Meanwhile, the latter approach based on the analysis of the characteristics of the modules of the apparatus of the IR, loses its significance, if multiple surgeries are performed through identification�tion perfezionamento equipment. Then the variability postperfusion gemoglobinemii will depend on the individual characteristics of the patient that remain unaccounted for in cardiac surgery patients without pathology of the blood system.

The closest method to the prediction of marked hemolysis in patients with CHD after surgery with CPB is a way to combine the evaluation of mechanical, acid, osmotic resistance of red blood cells and the permeability of their membranes prior to surgery. It is shown that a pronounced intraoperative hemolysis (concentration of free hemoglobin in the blood more than 40 mg/DL) develops in patients with CHD and high permeability of the erythrocyte membrane, acidic and low mechanical resistance of cells and normal value of the minimum of their osmotic resistance before surgery; moderate hemolysis (less than 40 mg/DL) - in CHD patients with normal membrane permeability of red blood cells, normal acid, mechanical resistance of cells and a high value of the minimum osmotic resistance of red blood cells prior to surgery [6]. Although the application of this method is possible in cardiosurgical patients suffering from hematological diseases, and without them, the implementation of the method requires four additional methods of research of the blood system, which �e included in the standard program of preoperative examination of patients with coronary artery disease. The latter will determine the complexity of this method and its costs due to the need to use special chemicals and laboratory equipment. In addition, in this method, there is no clear criterion for predicting pronounced hemolysis and are not determined the accuracy of his predictions.

New technical problem - increasing the accuracy and informative way, ensuring its availability for clinical use.

To solve the problem in the method of predicting moderate and pronounced hemolysis after coronary artery bypass surgery under extracorporeal circulation, by assessing the health status of the patient before the operation, characterized in that take into account the presence/absence of diseases of the lungs and kidneys, C-antigen of Rhesus erythrocytes, hyperfibrinogenemia greater than 4 g/l and the content of erythrocytes in the blood in amounts to 4.81×1012/l or less, and expect the risk of hemolytic perfusion (SRC) by the formula

Frac=(6,38×Xlay+8,93×XGBF+3,32×XAr)-(4,10×Xthe soil+2,95×XWith),

where 6,38; 8,93; 3,32; 4,10; 2,95 - the numerical values of the coecients;

Xlay- the presence (1)/absence (0) lung diseases;

XGBF- the presence (1)/absence (0) of hyperfibrinogenemia before the operation;

XAr- the presence (1)/absence (0) of the concentration of eritr�of cítov in the blood before the operation to 4.81×10 12/l or less;

Xthe soil- the presence (1)/absence (0) of kidney disease;

XWith- the presence (1)/absence (0) of erythrocytes on the C-antigen of the RH;

and when EMG value>6,0 predict the development of pronounced hemolysis after the operation, when hydraulic fracturing<6,0 - development of moderate hemolysis.

The method is as follows.

In a patient with diagnosed coronary heart disease, which is planned to perform coronary bypass surgery in terms of IR, register, on the basis of its clinical data card, the fact of presence of diseases of the lungs and kidneys, the presence of the antigen in the RH system in the erythrocytes, the red blood cells to 4.81×1012/l or less, high fibrinogen concentration (more than 4 g/l) in blood before surgery, and then compute the score of hydraulic fracturing by the formula

Frac=(6,38×Xlay+8,93×XGBF+3,32×XAr)-(4,10×Xthe soil+2,95×XWith),

where Xlay, Xthe soil, XGBF, XAr, XWith- variables of the corresponding features (lung pathology, renal pathology, hyperfibrinogenemia, the content of red blood cells With the antigen of the RH system) whose value is equal to "I" if the corresponding indication exists, or "0" if it does not exist; SRC>6,0 projected development of pronounced hemolysis after the operation, when hydraulic fracturing<6,0 - formation moderate hemoglobinemia.

Despite the development �extracorporally technologies, intensification of intravascular hemolysis by IR during surgery on a stopped heart is a required component postperfusion reactions of the patient. Massive hemoglobinemia substantially impairs the function of the kidney due to obstruction of the renal tubules coagulated hemoglobin, and also due to the induction of free radical processes in the renal epithelium and the worsening of the ischemic kidney as a result of binding of molecules of nitric oxide (NO). Similarly, free hemoglobin mediates the expressed disturbances of the microcirculation in all organs and tissues, which is further enhanced by occlusion of microvascular fragments of membranes lysed cells and the potentiation of post-hemorrhagic anemia hemolytic component. The negative consequences of high gemoglobinemii become detectable only in cases of severe hemolysis, exceeding the clinically significant level of 40 mg/DL (concentration of free hemoglobin in the blood). If hemoglobinemia reasonable and not beyond the threshold of 40 mg/DL, adverse effects of hemolysis is not detected. In this regard, prediction of the possible development of moderate or pronounced hemolysis after IR is an actual problem of cardiac surgery, perfusely and resuscitation.

Among the contributing�their (exogenous) factors in the development of pronounced hemolysis specifics perfezionamento components: the severity of hemoglobinemia increases during prolonged in vitro perfused, the intensive work the coronary suction, deep hypothermia, high values of hematocrit and oxygenation of the blood during surgery, transfusion of donor erythrocyte mass. Predisposing (endogenous) factors include dysfunction of red blood cells in the blood system diseases - sickle cell anemia, thalassemia, anemia due to a genetically determined deficiency of glucose-6-phosphate dehydrogenase, disease cold agglutinins.

It was noticed that in cardiac surgery patients not suffering from hematological pathology and operated approximately equal conditions, the severity of postperfusion gemoglobinemii highly variable. Therefore, the severity of intraoperative hemolysis depends on the clinical status of the patient at the time of surgical intervention, given before surgery which could predict the development of moderate or pronounced intravascular hemolysis after IR.

Development of the proposed method for the prediction of moderate and pronounced hemolysis in cardiac surgery patients based on the analysis of the available parameters of the clinical status of patients with coronary artery disease before surgery (medical records) based on the results of the following clinical and experimental research.

Taken comprehensive clinical and laboratory�Torno a survey of 150 patients with coronary artery disease, undergoing coronary artery bypass grafting, which after 1 h after IR was evaluated by the concentration of free hemoglobin in the blood and divided patients into 2 groups - patients with moderate hemolysis (concentration of free hemoglobin in the blood is less than 40 mg/DL; 98 persons) and patients with severe hemoglobinemia (concentration of free hemoglobin in the blood 40 mg/DL or more; 52). In this case prior to surgery according to clinical patient cards recorded the duration of coronary heart disease, angina functional class and circulatory failure, presence of comorbidities, fibrinogen, red blood cells and hemoglobin in the blood, AB0 - and RH phenotype of red blood cells, the biochemical analysis of blood (concentration of total protein, urea, creatinine, total and direct bilirubin, activity of alanine - and aspartate aminotransferase).

Patients included in the study, provided the following criteria:

1. Men and women from 48 to 70 years old, suffering from coronary heart disease (angina and underwent coronary bypass surgery in terms of IR.

2. A written informed consent to participate in the study.

Exclusion criteria from the study were considered:

1. Exacerbation of chronic comorbidity;

2. The presence of hematolo�algebraic diseases (anemia, chronic leukemias);

3. The presence of acute respiratory illness 3 weeks before surgery;

4. Appointment courses oxygen therapy, erythropoietin or iron;

5. Execution combined with coronary bypass grafting operations (resection of aneurysms of the aorta or left ventricle, correction of heart defects, the removal of the myxoma, surgery to restore blood flow through the carotid arteries and arteries of lower extremities);

6. The presence infusion of Packed red cells during perfusion;

7. Duration IR over 240 min;

8. The rejection of the study.

The diagnosis of CHD was established on the basis of complaints and anamnesis of a patient, the data of electrocardiography, echocardiography, cardioventilatory, as well as scintigraphy and emission computed tomography myocardial. In the presence of hemodynamically significant stenosis of two or more coronary arteries (more than 75% of the cross-sectional area of the vessel) and/or complete occlusion of the left main coronary artery were assigned to coronary artery bypass grafting.

Among CHD patients of both study groups were dominated by males suffering from angina III functional class, heart failure functional class II (NYHA) and hypertension 3 degrees, having as CONV�existing pathology mainly diseases of the gastrointestinal tract (table.1). In patients with moderate hemolysis significantly more frequent kidney disease and in persons with severe hemoglobinemia - lung disease (table.1).

Extracorporeal perfusion was carried out on the IR device "Stokert" ("SORIN GROUP DEUTSCHLAND", Germany), equipped with a roller pump, with disposable membrane oxygenator "Quadrox" (MAQUET AG, Germany). To fill primary volume of the device IR used saline in a volume of 1200 ml and polyglukin 400 ml. Volumetric perfusion rate was calculated based on the perfusion index of 2.5 l/min/m2and the surface area of the patient's body. Extracorporeal perfusion was carried out under conditions of normothermia (36,09±0,26°C) and antegrade cardioplegia with a solution "Custodiol" ("Dr. F. Koehler Chemie GmbH, Germany). Conditions in the groups of the examined patients were comparable, except for the duration of the IR and the magnitude of maximum oxygenation of the blood during perfusion, in patients with severe hemolysis was slightly higher than those in patients with moderate hemoglobinemia (PL.2), which could be due to concomitant pathology of the lungs, the most characteristic for the first group of patients.

At the preoperative stage CHD patients was conducted antianginal therapy with the use of nitrates prolonged action (isosorbide-5-mononit�at), beta1-blockers (bisoprolol, metoprolol), blockers of Ca2+channels (felodipine, amlodipine). Also implemented antihypertensive therapy with inhibitors of angiotensin-converting enzyme (enalapril, spirapril, perindopril, fosinopril and diuretics (spironolactone, indapamide, furosemide); were prescribed antiplatelet agents (acetylsalicylic acid, clopidogrel) and anticoagulants (heparin, Fraxiparine). Correction of lipid metabolism were carried out with use of statins (atorvastatin, simvastin). In diabetes type 2 diabetes were prescribed hypoglycemic drugs (glibenclamide, gliclazide, Metformin); ulcers in the stomach and/or duodenum - ulcer therapy (omeprazole, ranitidine). In the intraoperative period in patients of coronary artery disease was carried out intravenous infusion of ketamine 5%, fentanyl 0,005%, promedol 2%, morphine 1%, diazepam 0,5%; diphenhydramine hydrochloride 1%, of droperidol of 0.25%, lidocaine 10%, atropine 0,1%, pentamine 5%, pipekuronia of 0.2%, suksametonia 2%, nitroglycerin 1%, heparin 5000 IU/ml, etamzilata of 12.5%, aminocaproic acid 5%, prednisolone 2.5 per cent, Ceftriazone 1 g, sultanina 1.5 g, furosemide 1%. In some cases, according to the testimony introduced sympathomimetics (epinephrine, depmin, phenylephrine) or blockers (metoprolol, albator, abronhill), insulin, verapamil. Preoperative treatment and intra�arziona farmakokorrektsiya physiological functions of the patient were not very different in the studied groups.

The analysis of the above parameters of the clinical status of patients with coronary artery disease before surgery in relation to the concentration of free hemoglobin in the blood after perfusion. Venous blood taken from the cubital vein after 1 h after IR, Gaprindashvili (50 U/ml) and separated the plasma, which determined the concentration of free hemoglobin benzidine method. To registered on the histories of the parameters of the clinical status of patients before surgery, which differed in the studied groups of individuals (frequency of occurrence of diseases of the kidneys and lungs, fibrinogen and red blood cells in the blood, the expression on erythrocytes B-antigenic system AB0 - and C-antigen of the RH), was calculated ratios for the Association of these traits with the fact that the development of pronounced hemolysis and in the case of a statistically signicant value (p<0.05) was adopted that trait affects the severity of hemolysis and is a factor in its forecast. Among the studied parameters so were the incidence of diseases of the kidneys and lungs, hyperfibrinogenemia (more than 4 g/l), red blood cells in the blood to 4.81×1012/l or less, the expression on erythrocytes C-antigen of the RH system.

For the above factors, the expected value of the odds ratio (OR) for the development of severe and moderate hemoglobinemia in patients after IR. �ylo installed, that the OR for the incidence of lung pathology, hyperfibrinogenemia (more than 4 g/l) and the contents of cells in the blood to 4.81×1012/l or less exceeding 1.0 (4,80; 6,16 and 2.44, respectively) and therefore were regarded as risk factors for the development of marked hemolysis. OR for the frequency of occurrence of diseases of the kidneys and the presence of the C-antigen of Rhesus erythrocytes, in contrast, did not reach 1,0 (of 0.38 and 0.64, respectively), therefore, were interpreted as protective factors.

Due to the fact that OR only shows the likelihood of pronounced hemolysis after surgery, reflecting the degree of influence of the corresponding factor on the level of hemoglobinemia, for each of the prognostic significance of symptoms was calculated the ratio of the average concentration of free hemoglobin in plasma after IR in patients with an appropriate indication, compared to same period in patients who have not had it (K), regardless of the severity postperfusion hemolysis. The value of K was for the frequency of occurrence of lung pathology 1,33; for hyperfibrinogenemia 1,45; low content of red blood cells (to 4.81×1012/l or less) to 1.36; for the frequency of occurrence of kidney diseases 0,64; for the presence of the C-antigen of Rhesus erythrocytes of 0.42. For the purpose of considering the influence of both characteristics (OR, and K) on the severity of GE�of Olisa their values perennial, getting the numerical coefficients. The risk factors signified by the sign "+", and protective signs " - " sign, presenting the latter as the risk of developing moderate hemoglobinemia, OR, and K which is the reciprocal OR and K pronounced hemolysis (then to kidney disease OR SIGmoderate=1/0,38=2,63 and Kmoderate=1/0,64=1,56; for S-antigen OR SIGmoderate=1/0,42=2,38 and Kmoderate=1/0,81=1,24). Thus, the formula for calculating the total score risk of hemolytic perfusion (EMG) is

Frac=(4,80×1,33×Xlay+6,16×1,45×XGBF+2,44×1,36×XAr)-(2,63×1,56×Xthe soil+2,38×1,24×XWith);

Frac=(6,38×Xlay+8,93×XGBF+3,32×XAr)-(4,10×Xthe soil+2,95×XWith),

where 6,38; 8,93; 3,32; 4,10; 2,95 - the numerical values of the coecients;

Xlay- the presence (1)/absence (0) lung diseases;

XGBF- the presence (1)/absence (0) of hyperfibrinogenemia before surgery (more than 4 g/l);

XAr- the presence (1)/absence (0) of the concentration of erythrocytes in the blood before the operation to 4.81×1012/l or less;

Xthe soil- the presence (1)/absence (0) of kidney disease;

XWith- the presence (1)/absence (0) on the red blood cells With antigen of the RH system.

For the purpose of establishing a critical value of the EMG score that predicts the formation of a pronounced gemoglobinemii after surgery with IR developed by the empirical formula RA�couple fracturing was applied to 46 patients (25 patients with moderate and 21 patients with severe hemolysis), have all the indicators used in the equation were determined simultaneously.

It was found that the value of the average score of EMG in patients with severe hemoglobinemia was more such in an alternative group of patients (8,85±0,44 points against - 0,15±0.86 points, p<0.001) and confidence interval values of hydraulic fracturing in the first case was (4,85; 12,85). Due to the fact that this band belonged to the 4 values of hydraulic fracturing, occurring in both groups of patients (5,96; 6,74; of 6.79 and 9.70 points, while the value 9,70 were excluded from the sample of patients with moderate hemolysis, according to the "rule 2σ"), and the parameter SRC is a discrete variable, it is possible to identify a critical level of EMG remaining 3 values (5,96; 6,74; of 6.79) alternately taken as the critical with the subsequent calculation of parameters of diagnostic information (sensitivity, specificity, efficiency). The highest values were obtained in the last case, the attribution of "5,96" to a group of patients with moderate hemoglobinemia, and "6,74" and "of 6.79" - the group of patients with severe hemolysis (table.3), therefore, as the critical level of EMG were assumed 6,00.

Therefore, if a patient is calculated as the value of hydraulic fracturing operations to exceed 6,00 points after IR, we should expect the development of pronounced hemolysis and ve�aatest this event is 0,818 (in this study, 18 of 22 patients with coronary artery disease, which fracturing predicted the development of severe hemoglobinemia and she is really formed). That is, the predictive value of a positive result is equal to 81.8 per cent, which, together with the predictive value of a negative result equal to 87.5% (21 of 24 patients with coronary artery disease prognosis moderate hemolysis fracturing confirmed), characterizes the prognostic significance of the developed EMG parameter (tab.3).

The calculation of diagnostic sensitivity, specificity and efficacy of the scale EMG showed high values of these characteristics remains above the 80% level (table.3), which confirms the diagnostic reliability of the use of this system predict a pronounced and moderate intraoperative hemolysis in cardiac surgery patients developed by the empirical formula.

It should be noted that analysis of variance between the amount gemoglobinemii after IR and its duration, as well as the size of gemoglobinemii and maximum level of oxygenation of the blood during perfusion found a weak influence of these factors on the hemolysis, as the share of inter-group variance to the total variance of the sample in the first case amounted 10,81% (p<0.05) and in the second - 13,35% (p<0,05), which determines the amount of not more than 25% of variability in intraoperative hemolysis, demonstrating in�high importance in this process the individual characteristics of the clinical status of the patient prior to surgery.

The examples on the implementation of the method.

Example 1. Patient D., age 60. The diagnosis of coronary artery disease. Angina III functional class, postinfarction cardiosclerosis (2010), circulatory failure II NYHA functional class, duration of CHD 4 years. Comorbidities: hypertension 3 degrees, chronic gastritis (remission), benign hyperfunctioning of the prostate gland, cyst of the left kidney, reducing its filtration sposobnosti. The content of erythrocytes and fibrinogen in the blood before the operation is 4.8×1012/l and 3.5 g/l, respectively, incomplete Rhesus phenotype of erythrocytes "Cc". The duration of artificial circulation was 96 min, average perfusion: temperature 35,49°C, the volumetric perfusion rate 5.5 l/min, the intensity of the coronary suction 728 ml/min, the level of blood oxygenation 156 mm Hg.CT., the hematocrit a 24.5%; intraoperative transfusion of Packed red blood cells was not performed, the disease red blood in the last 6 months before surgery were noted.

A study according to the proposed method.

Due to the fact that in this patient there was no lung disease and hyperfibrinogenemia, the corresponding variables in the formula acquires the value "0". The content of erythrocytes in the blood less to 4.81×1012/l, the presence of renal disease and C-antigen mauritanica defines the value of the data variable as "1". The adopted values of variables to replace in the formula for calculating the score of hydraulic fracturing

Frac=(6,38×Xlay+8,93×XGBF+3,32×XAr)-(4,10×Xthe soil+2,95×XWith)=(6,38×0+8,93×0+3,32×1)-(4,10×1+2,95×1)=3,32-7,05=-3,73 points.

Since the obtained value of EMG: -3,73<6,00, the patient before surgery predicted the development of moderate hemolysis after IR. The prediction was correct, because the concentration of free hemoglobin in the blood after perfusion was 20.7 mg/DL and did not exceed the threshold for a clinically significant hemolysis (40 mg/DL) that due to the formula developed was determined before and after surgery and was associated with a lack of protein in the urine during the entire postoperative period, small volume of pleural exudate after surgery (200 ml on the 3rd day after surgery), the average period of postoperative hospitalization (19 days); urine output on the 2nd day after surgery was 2100 ml. meanwhile, under existing until now, the traditional approach in predicting the severity of hemolysis after surgery on the basis of analysis of the conditions of its carrying out, somewhat elevated (exceeding the average level) flow rate of perfusion and the intensity of the coronary suction suggests the development of significant hemolysis after the operation, which, however, is not formed, is obvious�bottom, due to the high hemolytic resistance of erythrocytes.

Example 2. Patient Z., aged 64. The diagnosis of coronary artery disease. Angina III functional class, postinfarction cardiosclerosis (2007), circulatory failure (III NYHA functional class, duration of CHD 9 years. Comorbidities: hypertension 3 degrees, gastric ulcer disease (in remission), chronic obstructive pulmonary disease 1 degree. The content of erythrocytes and fibrinogen in the blood before the operation, respectively 4,52×1012/l 3.9 g/l, partial Rhesus phenotype of erythrocytes "cc". The duration of artificial circulation was 132 min, average perfusion: temperature 36,14°C, the volumetric perfusion rate of 5.2 l/min, the intensity of the coronary suction 627 ml/min, the level of blood oxygenation 169 mm Hg.CT., hematocrit of 22.6%; intraoperative transfusion of Packed red blood cells was not performed, the disease red blood in the last 6 months before surgery were noted.

The study soglasno the proposed method. Due to the fact that in this patient was missing hyperfibrinogenemia, C-antigen on erythrocytes and kidney disease, then the appropriate variables in the formula acquires the value "0". The content of erythrocytes in the blood less to 4.81×1012/l and the presence of lung pathology defines the value of the data re�enny as "1". The adopted values of variables to replace in the formula for calculating the score of hydraulic fracturing

Frac=(6,38×Xlay+8,93×XGBF+3,32×XAr)-(4,10×Xthe soil+2,95×XWith)=(6,38×1+8,93×0+3,32×1)-(4,10×0+2,95×0)=9,7-0-9,7 points.

Because 9,7>6,00, the patient before surgery predicted the development of pronounced hemolysis after IR. The prediction was correct, because the concentration of free hemoglobin in the blood after perfusion was 63.1 mg/DL and exceeded the threshold for a clinically significant hemolysis (40 mg/DL) that due to the formula developed was determined before and after surgery and was associated with the appearance of protein in the urine (0,48 g/l on the 4th day after the operation), a significant volume of pleural exudate after surgery (350 ml on the 3rd day after surgery) and prolonged postoperative hospitalization (23 days); diuresis on the 2nd day after the operation amounted to 1650 ml. meanwhile, according still to the traditional approach in predicting the severity of hemolysis after surgery by analyzing the conditions of its implementation, increased (exceeding the average level) indicators IR duration and oxygenation of the blood during perfusion testified in favor of the development of significant hemolysis after surgery, and low hematocrit values, in contrast, suggests the development of irrelevant hemoglobinemia. �besides in this patient, there were no diseases of the hematological profile, which also did not give reason to expect a pronounced hemoglobinemia. Thus, the prediction of hemolysis on the basis of the operation conditions and the presence/absence of clinically verified pathology of the blood system is inconsistent, while applying the formula allowed us to accurately predict the formation of clinically significant hemolysis.

Thus, the application of the proposed method of predicting the development of moderate or marked hemolysis in patients with CHD after surgery with IR, and its introduction into clinical practice of cardiac surgery hospitals will allow even at the preoperative stage without conducting additional investigations to predict the development of clinically significant hemolysis and probable hemolytic complications after perfusion, which will give the opportunity to carry out pharmacological primary prevention of hemolysis at risk, as well as to modify tactics perfezionamento support to the operation. Overall, the result of application of the method will be expressed in improving the quality of life of patients in the early postoperative period, reducing the costs of health care resources at their post-operative rehabilitation and reducing mortality ka�dihydrolysergic patients from hemolysis-mediated complications.

Sources of information

1. Sickle cell disease and complex congenital cardiac surgery: a case report and review of the pathophysiology and perioperative management / D. Sanders, B. Smith, S. Sowell et al. // Perfusion. - 2013.

http://www.ncbi.nlm.nih.gov/pubmed/?term=1.%09Sickle+cell+disease+and+complex+con genital+cardiac+surgery%3A+a+case+report+and+review+of+the+pathophysiology+and+p erioperative+management

2. Dogra N. Glucose-6-phosphate dehydrogenase deficiency and cardiac surgery. / N. Dogra, G. D. Puri, S. S. Rana // Perfusion. - Vol.25, N6. - P. 417-421.

3. Findlater, R. R. When blood runs cold: cold agglutinins and cardiac surgery / R. R. Findlater, K. N. Schnell-Hoehn // Can. J. Cardiovasc Nurs. - 2011. - Vol. 21, N2. - P. 30-34.

4. Standardization of intraoperative assessment of hemolysis during cardiac surgery under extracorporeal circulation. / / I. Dementieva, Y. A. Morozov, M. A. Charney et al. / / Cardiology and cardiovascular surgery. - 2010. - No. 4. - P. 75-78.

5. Vercamest, L. Hemolysis in cardiac surgery patients undergoing cardiopulmonary bypass: A review in search of a treatment algorithm / L. Vercamest // The J. of Extra Corporeal Technology. - 2008 - Vol.40, N4. - P. 257-267.

6. Maltseva I. V. Characteristic resistivity of red blood cells in cardiac surgery patients with varying degrees of severity postperfusion hemolysis. / V. I. Maltsev // Bulletin of Siberian medicine. - 2013. - Vol. 12, No. 1. Pp. 69-74.

Application

Table 1

Clinical characteristics of the studied groups of patients with coronary artery disease before coronary artery bypass surgery under extracorporeal circulation

Note. Hereinafter in the table.2: IHD - ischemic heart disease, NYHA (New York HeartAssociation) - The new York heart Association, p - level of statistical significance of differences between the groups surveyed.

Table 2

Feature perfezionamento stage coronary artery bypass surgery in patients with coronary heart disease

Note: Cm. table.1, pO2 - partial pressure of oxygen in the blood, HbO2- the degree of oxygen saturation of hemoglobin, Hct - hematocrit.

Table 3

The parameters of diagnostic information of the scale of risk of hemolytic perfusion in patients with coronary heart disease

Note: EMG - hemolytic risk of perfusion.

Fig.1. The distribution of score risk of hemolytic perfusion units (Pius) in cardiac surgery patients depending on the severity of intraoperative hemolysis

Table 1
IndicatorCHD patients with moderate postoperative hemolysisCHD patients with severe postoperative hemolysis
Number of patients:9852
men, %85,71±3,5590,38±4,13
women, %14,29±3,559,62±4,13
Age, years59,42±1,0859,38±1,22
The duration of disease, years5,08±0,94Is 5.33±1,04
Functional class of anginaII %18,37±3,93To 19.52±5,55
III %76,53±4,3071,15±system 6.34
IV, %5,10±2,239,62±4,13
Functional class of heart failure (NYHA)I,%11,22±3,215,77±3,27
II %80,61±4,0176,92±5,90
III %8,17±2,7817,31±5,30
Ejection fraction of the left ventricle, %62,95±1,8158,48±2,24
Hype�tonic disease III, %92,59±2,6191,67±3,73
Chronic venous insufficiency, %18,37±3,93Of 21.15±5,72
Diabetes mellitus type 2, %Of 14.28±3,55For 15.39±5,05
Thyroid dysfunction, %10,21±3,073,85±2,69
Dysfunction of the prostate, %18,37±3,939,62±4,13
Pathology of the gastrointestinal tract, %85,71±3,5591,67±3,73
Diseases of the liver and biliary tract, %25,51±4,4342,31±at 6.92
Diseases of the urinary system, %40,82±system 6.34Of 21.15±5,72, p<0,05
Lung disease, %10,21±3,0732,69±6,57 p<0.01
Peripheral�nny risk Euroscor, %2,00±0,232,96±0,54

Table 2
IndicatorCHD patients with moderate postoperative hemolysisCHD patients with severe postoperative hemolysis
The duration of cardiopulmonary bypass, min100,15±2,73123,10±levels lower than the 5.37, p<0,001
The duration of ischemia, min65,92±5,2088,74±of 7.19, p<0.01
Swaps average, l/min5,27±0,115,21±0,09
Swaps the maximum l/min5,38±0,135,39±0,11
pO2mean, mm Hg.PT.150,80±5,87149,18±5,28
pO2maximum, mm Hg.PT.Of 185.02±7,26207,54±of 5.29 p<0,05
HbO2average, %98,34±0,5198,57±0,26
HbO2minimum, %97,01±0,8297,20±0,43
Hct average, %The 24.75±1,1224,53±0,75

Hct minimum, %23,09±0,7722,88±0,70
The temperature of the perfusion medium, °C36,08±0,1436,12±0,35
The perfusion temperature minimum °C35,44±0,1535,75±0,27
The intensity of the coronary suction, ml/min683,34±46,69646,27±EUR 50.12
The proportion of patients with different number of shunted arteries, %2 artery25,00±6,069,09±4,38
3 artery42,31±at 6.9245,83±7,60
4 artery28,85±system 6.3440,91±7,49
5 arteries 3,85±2,694,55±3,18

Table 3
Parameter diagnostic information of hydraulic fracturingThe value of parameter diagnostic information of SRC with its critical value is $ 6,00
The diagnostic sensitivity, %85,7
Diagnostic specificity, %84,0
Diagnostic efficiency, %84,8
The predictive value of a positive result, %81,8
The predictive value of a negative result, %87,5

A method of predicting moderate and pronounced hemolysis after coronary artery bypass surgery under extracorporeal circulation, by assessing the health status of the patient before the operation, characterized in that take into account the presence/absence of diseases of the lungs and kidneys, With the antigen of Rhesus erythrocytes, hyperfibrinogenemia greater than 4 g/l and the content of erythrocytes in the blood in amounts to 4.81×1012/l and IU�her, and expect the risk of hemolytic perfusion (SRC) by the formula
Frac=(6,38×Xlay+8,93×XGBF+3,32×XAr)-(4,10×Xthe soil+2,95×XWith),
where 6,38; 8,93; 3,32; 4,10; 2,95 - the numerical values of the coecients;
Xlay- the presence (1)/absence (0) lung diseases;
XGBF- the presence (1)/absence (0) of hyperfibrinogenemia before surgery;
XAr- the presence (1)/absence (0) of the concentration of erythrocytes in the blood before the operation to 4.81×1012/l or less;
Xthe soil- the presence (1)/absence (0) of kidney disease;
XWith- the presence (1)/absence (0) on the red blood cells With antigen of the RH;
and when EMG value>6,0 predict the development of pronounced hemolysis, and when hydraulic fracturing<6,0 - development of moderate hemolysis after surgery.



 

Same patents:

FIELD: biotechnologies.

SUBSTANCE: invention can be used for determination of atherogenicity of immune complexes containing multiply modified low density lipoproteins (IC-MMLDLP). For this purpose basic calcium superphosphate of IC-MMLDLP is prepared from human blood serum by treatment with the buffer containing 10% solution of polyethyleneglycol with a molecular weight 3350 (PEG-3350), in the ratio 1:2.5, then it is incubate within 10 minutes at a room temperature. IC-MMLDLP aggregates are pelleted, dissolved in the buffer without PEG-3350, analysed for the content of cholesterol in immune complexes (ChIK) and the level of guinea pig complement binding (EBC) by precipitated immune complexes. IC-MMLDLP atherogenicity is calculated as SSK to HIK ratio. If the value is below 24 units a high blood atherogenicity because of the reduced complement activating IgG function in IC-MMLDLP is stated.

EFFECT: method allows to assess IC-MMLDLP atherogenicity, diagnose atherosclerosis at a preclinical stage, and also to predict both the course of atherosclerotic process at individuals, and efficiency of the conducted therapy.

1 tbl

FIELD: medicine.

SUBSTANCE: invention can be used for the instant assessment of atherogenicity of the immune complexes (IC) of human blood serum. Precipitated ICs from human blood serum are prepared by treating with a buffer containing 10% polyethylene glycol of molecular weight 3,350 (PEG-3350) in ratio 1:3.5, incubating for 10 min at room temperature. Aggregated ICs are deposited by centrifuging and dissolved in PEG-3350 free buffer; the immune complex cholesterol (ICC) is measured, and a guinea pig's complement fixation (CF) by the precipitated immune complexes is determined. The IC atherogenicity is calculated as CF/ICC relation, and if the derived value is less than 4 units, the high blood atherogenicity is stated.

EFFECT: higher assessment accuracy.

1 tbl

FIELD: medicine.

SUBSTANCE: measured are: erythrocyte sedimentation rate, total bilirubin, prostacyclin, erythrocyte aggregation, blood viscosity in microcirculatory vessels, carbamide, adhesion of thrombocytes, plasminogen and nitrites. The measured data are used to assess the erythrocyte membrane resistance by coefficient (Kms). If Kms is -0.1 or less, the erythrocyte membrane appears to be ischemic resistant, while Kms of 0.0 or more shows the ischemic resistant membrane.

EFFECT: using declared method enables fast, accurate and objective assessment of the individual ischemic resistance of erythrocytes.

2 ex

FIELD: medicine.

SUBSTANCE: invention represents a method for predicting rhinosinusitis polyposa in the patients with bronchial asthma, which is implemented by analysing the patient's blood to measure endotoxemia parameters as follows: leukocytes, average weight molecules, creatinine, carbamide and erythrocyte sedimentation rate; the prediction is made by a discriminant equation: D=6.900×leukocytes(×10^9/l)+2.640×erythrocyte sedimentation rate (mm/h)+17.819×average weight molecules (absorbance units)+1.127×creatinine (mcmole/l)+24.801×carbamide(mcmole/l), wherein D is a discriminant function having a threshold value of -223.12; if D is equal or more than the limit, rhinosinusitis polyposa is predicted in the patients with bronchial asthma, and if D is less than the limit, the patients with bronchial asthma are predicted to develop rhinosinusitis polyposa.

EFFECT: provided high-accuracy prediction of rhinosinusitis polyposa in the patients with bronchial asthma.

2 ex

FIELD: medicine.

SUBSTANCE: predicting the efficacy of a combined antiviral therapy (AVT) of chronic hepatitis C (CHC) with using regression analysis is ensured by calculating a virology response prediction coefficient (VRPC). VRPC=-3.581+eosinoph. *0.073- monocytes *0.012+lymphocytes *0.0772- bilirubin *0.098+ALT*0.7357+glucose *0.1049, wherein eosinoph. is the respective (%) eosinophil count in peripheral blood; monocytes is the respective (%) monocyte count in peripheral blood; lymphocytes is the respective (%) lymphocyte count in peripheral blood; bilirubin is total indirect bilirubin in venous blood, mcmole/l; ALT is the alanine-aminotransferase amount in venous blood, units per litre; glucose is the glucose amount, mmole/l. If the derived VRPC value is 319 or less, the absence of the stable virology response is predicted. If the VRPC value is more than 319, the stable virology response formed by the antiviral treatment is predicted.

EFFECT: using the given method enables predicting the antiviral therapeutic outcome by a personalised approach, and individualising the selection of a therapeutic sequence.

2 ex

FIELD: medicine.

SUBSTANCE: invention describes a method for increasing blood cell membrane permeability for drug deposition involving adding drugs to cell mass prepared by blood centrifugation; that is followed by photohemotherapy with drug containers presented by erythrocytes recovered from the cell mass after thrombocyte-leukocyte film formed by centrifugation is removed, and washed in normal saline; the erythrocytes are placed in a drug medium and exposed to ultraviolet at wavelength 360 nm and total radiation dose 0.72 J/cm2.

EFFECT: method increases accuracy and information value of the analysis.

3 tbl, 1 ex

FIELD: medicine.

SUBSTANCE: neutrophil granulocytes recovered from healthy donors' peripheral blood are exposed to light generated by light diodes having colour temperature 4,000-4,500K within the range of wave length 320-400 nm and light flux intensity 0.003 Wt/m for three various time intervals. That is followed by recording an increase or a decrease of phagocytic, lysosomal, and HCT-reducing activity of neutrophil granulocytes by more than 15% of the reference values; varying functional activity of neutrophil granulocytes enables stating the biological effects of the LED-lighting on functional activity of neutrophil granulocytes.

EFFECT: using the given method enables the objective assessment of the human body exposure to physical factors with using simulated cell cultures of neutrophil granulocytes.

3 tbl

FIELD: medicine.

SUBSTANCE: invention relates to the field of medicine and can be applied in medical diagnostics and therapy. A method of determining physical-biological parameters of skin and the concentration of haemoglobin derivatives in blood includes sending onto the skin polarised optical irradiation with a known spectrum, registration of signals of light diffusively-reflected by the skin with the polarisation, orthogonal to the polarisation of the sent onto skin radiation. Optical radiation is focused onto the skin surface into an irradiation spot, signals of light diffusively-reflected by the skin P(ρ, λ) in the spectral range λ=450-800 nm not less than from two ring areas on the skin surface, located at different distances ρ from the irradiation spot, are registered. Then the difference signals r(ρ, λ)=ln(P(ρ0, λ)/P(ρ, λ)) are determined, where ρ0 is adistance to the registration ring nearest to the irradiation spot, and the physical-biological parameters of the skin and the concentration of haemoglobin derivatives are determined by solution of an inverse problem with the application of analytical expressions, which approximate the dependence r(ρ, λ) on the determined parameters.

EFFECT: invention ensures accurate determination of parameters without the necessity to carry out calibrating changes and the increase of quantity of the determined parameters.

6 dwg,1 tbl

FIELD: medicine.

SUBSTANCE: analysed blood volumes are examined to measure contact coagulation intensity (CCI) prior to and after local hypoxia; that is followed by determining time (t0) from the beginning of the analysis to maximum amplitude decay of the viscoelastic blood properties (t1) after local hypoxia, and if CCI tends to reduce by 30% and more with increasing t1 by 30% and more, the anti-platelet endothelial function is considered to be normal, while increasing or unvarying CCI with increasing t1 by less than 30%, the anti-platelet endothelial function is considered to be diminished.

EFFECT: using the presented method enables increasing the diagnostic accuracy of the anti-platelet endothelial function by reducing the mechanical effect on blood corpuscles, reducing time and cost of the analysis.

5 dwg, 1 tbl, 4 ex

FIELD: medicine.

SUBSTANCE: blood angiogenic factors sFlt-1 and PIGF are measured in the pregnant women with clinically and laboratory diagnosed placental insufficiency (PI); that is followed by calculating the angiogenic coefficient Ka by formula: Ka=sFlt-1/(PIGF×10), and if Ka makes 250 or more, preeclampsia is predicted in the pregnant woman with PI.

EFFECT: method enables predicting preeclampsia in the pregnant women with PI for the purpose of selecting further therapeutic approach on the basis of the determined coefficient; in the end it enables making a decision on the rate and extent of clinical-laboratory examination involving all the measures conducted at a suspicion on preeclampsia.

4 ex

FIELD: medicine.

SUBSTANCE: invention relates to laboratory methods for blood analysis. Plasma is dropped in copper sulfate solution with density 1.023 g/cm3, not above, and time for drop falling on bottom of graduated cylinder with column height 243 mm is measured. The blood plasma density value is calculated by the formula:

wherein is the unknown blood plasma density (g/cm3); is copper sulfate solution density measured by areometer (g/cm3); t is average falling time of plasma drop in the copper sulfate solution (as seconds); 0.260130126 and 0.00290695 are correction coefficients. Temperature of plasma and copper sulfate solution is 20oC. Method is simple and suitable and allows carrying out analysis of small volumes of blood plasma and to reduce analysis time.

EFFECT: improved assay method.

2 ex

FIELD: medicine.

SUBSTANCE: method involves carrying out microscopic examination of blood serum samples taken from femoral vein and cubital vein. Femoral vein sample is taken on injured side. The examination is carried out before and after treatment. The blood serum samples are placed on fat-free glass slide in the amount of 0.01-0.02 ml as drops, dried at 18-30°C for 18-24 h. The set of pathological symptoms becoming larger or not changed after the treatment in comparison to sample taken before treatment, and morphological picture of samples under comparison taken from the cubital vein showing no changes or being changed to worse, the treatment is considered to be effective.

EFFECT: enabled medicamentous treatment evaluation in course of treatment to allow the treatment mode to be changed in due time; avoided surgical intervention (amputation); retained active life-style of aged patients.

4 dwg

FIELD: medicine, obstetrics, gynecology.

SUBSTANCE: in the first trimester of pregnancy one should study the content of CD8+CD11b lymphocytes and at their values being either equal or above 2% it is possible to predict gestosis. The present innovation enables to choose correct tactics of treating pregnant women that, in its turn, leads to decreased frequency of this complication of pregnancy and the risk for the development of fetal and neonatal pathology.

EFFECT: higher accuracy of prediction.

3 ex, 1 tbl

FIELD: medicine.

SUBSTANCE: the present innovation deals with studying and treating diseases of inflammatory, autoimmune and degenerative genesis. One should perform sampling of heparinized blood followed by its sedimentation to obtain blood plasma with leukocytes and centrifuging to isolate the latter which are washed against erythrocytic and serumal admixtures, and, also, it deals with calculating the number of cells in samples out of leukocytic suspension after incubation (B) for 1.5 h at 37 C in holes of plastic microplotting board, out of leukocytic suspension one should additionally prepare two samples, one should be applied to calculate total number of leukocytes before incubation (A), the second sample undergoes incubation at the same mode at addition of autoserum to calculate the number of cells remained after incubation (C). One should state upon adhesive properties of leukocytes by the index of spontaneous adhesion (D), where D=(A-B)/B.100%, and effect for enhanced cellular adhesion under the impact of autoserum should be detected by the value of K=(B-C)/C.100% at K ≥ 30%, where B - C - the number of cells undergone additional adhesion after addition of autoserum. The present innovation widens functional possibilities of the suggested method due to obtaining additional values depicting adhesive properties of blood leukocytes.

EFFECT: higher accuracy of detection.

FIELD: medicine, diagnostics.

SUBSTANCE: the present innovation deals with blood sampling, separating plasma against erythrocytes, moreover, in plasma on should detect activity of antithrombin III, proteins C and S, XIIa-dependent fibrinolysis and concentration of plasminogen obtained results should be expressed as relative units followed by calculating integral parameter that characterizes the state of anticoagulant-fibrinolytic potential (IPAFP) by the following formula: IPAFP = [(C1 + C2)/(C3 + C4)] x 100, where C1 - the ratio of observed value of antithrombin III activity to the value of inferior border of the range of analogous parameter norm; C2 - the ratio of observed value for the activity of proteins C and S system to the value of inferior border of the range of this parameter norm; C3 - the ratio of the value of inferior border of plasminogen concentration under normal conditions to observed value of analyzed parameter; C4 - coefficient calculated with the help of regression equation: C4 = 0.9 + (0.01 x X), where X - terms of lysis of patient's euglobulin clot/min, and at IPAFP value of 101.4 U and higher one should state anticoagulant-fibrinolytic blood potential to be in norm, in interval of 64.8 - 101.3 -as insufficient, and at 64.7 and below - as critical. The present method simplifies the procedure of evaluating the state of endogenous anticoagulants and activity of XIIa-dependent fibrinolysis.

EFFECT: increased diagnostic value of obtained results.

3 ex, 1 tbl

FIELD: medicine, laboratory diagnosis.

SUBSTANCE: method involves determination of the patient blood content of globulin-alpha 1, globulin-beta, globulin-gamma and the total bilirubin content followed by calculation of diagnosis indices for the patient (Y1, Y2, Y3) by using the computer program "Statistica 1.5" and introducing values X1, X2, X3 and X4 in computer wherein X1 means globulin-alpha 1 value; X2 means globulin-beta value; X3 means globulin-gamma value; X4 means total bilirubin value. Obtained values of diagnosis indices for the individual patient (Y1, Y2, Y3) are compared with average values of diagnosis indices (Y1', Y2', Y3') for different urogenital infections followed by comparison by sign and value. By the maximal coincidence of diagnosis index values for the individual patient with average diagnosis index values urogenital disease is diagnosed and the following diagnosis index average values are used: for chlamydiosis: Y1' = -2; Y2' = -0.1; Y3' = -0.2; for mycoplasmosis: Y1' = 2; Y2' = 0.8; Y3' = -0.04; for ureaplasmosis: Y1' = 2; Y2' = -1; Y3' = 0.02; for health persons: Y1' = -2; Y2' = 0.1; Y3' = 0.2. Invention provides the development of a method for express-diagnosis of infection at initial stage and diagnosis of atypical forms that occur in these diseases, and differential diagnosis of chlamydiosis, mycoplasmosis and ureaplasmosis. Invention can be used for carrying out the differential diagnosis of chlamydiosis, mycoplasmosis and ureaplasmosis.

EFFECT: improved method for express-diagnosis.

2 tbl, 4 ex

FIELD: medicine.

SUBSTANCE: method involves determining absolute value of ratio between lymphocyte number and absolute value of monocyte number in peripheral blood at the end of combine radiation therapy. The ratio is divided by 4.05. The result value being greater than 1, no disease relapse occurrence is predicted during the first observation year. The value being less than 1, tumor growth progress is stated and carcinoma relapse is predicted at the first year after treatment.

EFFECT: enhanced accuracy in detecting pathological process progress before observing clinical manifestations.

1 tbl

FIELD: medicine.

SUBSTANCE: method involves determining infrared radiation absorption coefficient in blood plasma in bandwidth of 1543-1396 cm-1. The infrared radiation absorption coefficient is determined in %. The value being equal to 29.7±1.1%, catarrhal cholecystitis is diagnosed. The value being 26.4±1.4%, phlegmonous cholecystitis is diagnosed. The value being 21.2±1.8%, gangrenous cholecystitis is diagnosed. The value being equal to 18.6±0.5%, gangrenous perforated cholecystitis case is diagnosed. The value in norm is equal to 32.4±0.8%.

EFFECT: high accuracy and specificity of diagnosis.

FIELD: biomedicine.

SUBSTANCE: the present innovation deals with biomedical measuring technologies, in particular, to those to detect bactericide activity of blood serum according to the level of its inhibiting impact upon luminescence intensity of sulfur-sensitive luminescent bacteria (ΣimpO) against control - luminescence intensity the same sulfur-sensitive luminescent bacteria that had no contact with blood serum (ΣimpK), then one should calculate the value of bactericide activity of blood serum by the following formula:

As sulfur-sensitive luminescent bacteria one should apply either natural or recombinant microorganisms being characterized by direct proportionality between intensity of decreased spontaneous bioluminescence level and degree of bactericide effect. For example, it is possible to apply Escherichia coli strain with genes of Photobacterium leiognathi luminescent system. The suggested method enables to shorten the duration for detecting bactericide activity of blood serum and decrease its labor intensity.

EFFECT: higher efficiency of detection.

1 cl, 1 ex, 1 tbl

FIELD: medicine.

SUBSTANCE: method involves determining blood insulin I and thyroxin T content and phagocytic leukocyte activity (PLA). Activity coefficient is calculated on the basis of formula KA=IxPLA/T. KA value being found greater than 2.8 units, considerable amelioration treatment effect is predicted. The value being from 1.4 to 2.8 units, amelioration is predicted. KA being less than 1.4 units, lower treatment efficiency is predicted.

EFFECT: high reliability of prognosis.

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